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Malaria prophylaxis in sickle cell anaemia: some answers, more questions
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Journal Article
Malaria prophylaxis in sickle cell anaemia: some answers, more questions
2025
Overview
More than 300 000 children are born with sickle cell anaemia within the region every year. 1 Until recently, most of these children would not receive specific treatment, leading to high levels of mortality in early life. 2 The importance of sickle cell anaemia is now being recognised in Africa, where multiple countries have recently developed guidelines for improved diagnosis and treatment, and even for newborn screening. In a commendable and challenging randomised, double-blind trial conducted in 725 children with sickle cell anaemia aged 6 months to 15 years (n=724 included in analysis), the incidence of clinical malaria, the primary endpoint, was significantly lower among children in the dihydroartemisinin–piperaquine group than the sulfadoxine–pyrimethamine group (incidence rate ratio [IRR 0·20 [95% CI 0·14–0·30]; p<0·0001). Despite the clear benefit of dihydroartemisinin–piperaquine prophylaxis against malaria, the high incidence of non-malaria events means that a formal policy switch from dihydroartemisinin–piperaquine to sulfadoxine–pyrimethamine for malaria prophylaxis could have unpredictable consequences on the overall health of children with sickle cell anaemia within the study areas.
Publisher
Elsevier Ltd,Elsevier Limited
